Cervical Ripening with Low-Dose Prostaglandins in Planned Vaginal Birth after Cesarean (original) (raw)
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Cervical ripening by prostaglandin E2 in patients with a previous cesarean section
Journal of Gynecology Obstetrics and Human Reproduction, 2020
To assess the efficacy and safety of prostaglandin in inducing labor in pregnant women with one previous cesarean section. Secondly, to evaluate predictors of successful vaginal delivery in cervical ripening by prostaglandin in these women. Study design: This was an observational, retrospective, single-center study conducted in a type 3 maternity unit at Bicêtre University Hospital between January 1, 2013 and December 31, 2016. Patients with one previous cesarean section, a singleton pregnancy, a fetus in the cephalic presentation with a medical indication for induction of labor and an unfavorable cervix (Bishop score less than 6) were included in the study. Cervical ripening was performed using a dinoprostone intravaginal device for a duration of 24 h. Results: A total of 153 patients were included in the study. The rate of vaginal delivery was 55.6 % (85/153) overall and 78.3 % (36/46) in the subgroup of 46 women with a previous vaginal delivery before or after the cesarean section. There was no difference in neonatal and maternal morbidity (defined by intraoperative wounds or postpartum hemorrhage or uterine rupture) and mortality between women who delivered vaginally and women who had a cesarean section. The two cases of complete uterine rupture have been reported for patients whose labor was induced by intravaginal prostaglandin followed by intravenous oxytocin. The total maternal morbidity rate was 11.8 % (n = 8/68) in the case of emergency cesarean section. Predictors of vaginal delivery were a history of vaginal delivery, the onset of labor following cervical ripening, and a higher Bishop score before and after the 24 h following the cervical ripening. Conclusion: Cervical ripening by prostaglandin after previous cesarean delivery has a 56 % success rate, with a 1.3 % risk of uterine rupture, especially when prostaglandin is combined with oxytocin. Low-risk patients should be identified to propose cervical ripening by prostaglandin.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: In modern medicine induction of labour is required in patients for a good feto-maternal outcome. PGE2 is a prostaglandin analogue which has been used as a cervical ripening agent to improve bishops score. Objective of this study was to evaluate the efficacy of intravaginal PGE2 gel as a cervical ripening agent in unfavourable cervix for induction of labor and any complications associated with its use.Methods: This study comprised of 90 women who required labor induction. Singleton pregnancy above 37 weeks, live intrauterine fetus, Cephalic presentation, Bishop score of 1-6, reactive FHR pattern were included. Women who required only single induction were categorized as Group 1. Those requiring more than one dose after reassessment of bishops scoring at 6, 12 and 18 hours belonged to Group 2.Results: Group1 had more of younger population below 30 years consisting more primigravidas with > 80% women having gestational age of > 39 weeks. Most common indication for ind...
American Journal of Obstetrics and Gynecology, 1992
OBJECTIVE: The purpose of this study was to determine if prostaglandin E2 in a controlled-release vaginal pessary can produce cervical ripening at term. STUDY DESIGN: This was a double-blind, randomized, placebo-controlled study conducted at a university center and involving 81 patients with 42 receiving active agent. Categoric data were analyzed by Pearson's x 2 or logistic regression. Continuous variables were analyzed by analysis of variance and the F test.
Journal of Lumbini Medical College, 2014
Objective: To compare the outcome of induction of labour with titrated dose of oxytocin with or without pre induction cervical ripening using prostaglandin E2. Methods: This is a prospective study. Sixty women with prelabour rupture of membranes (PROM) and Bishops score of less than six were randomly assigned to either immediate induction with intravenous oxytocin drip or induction with intravenous oxytocin drip preceded by cervical priming with prostaglandin E2 (PGE2) gel 0.5mg instilled intracervically. These two groups were compared regarding the mode of delivery, induction to delivery interval and maternal and neonatal morbidities. Results: Cervical priming with PGE2 resulted in lesser number of caesarean section (5 Vs. 12) and lower incidence of meconium stained liquor (n=6 Vs. n=2). Induction to vaginal delivery interval was shorter when cervical priming was done (5.4 hrs Vs 7.9 hrs). The maternal morbidity was negligible…
American Journal of Obstetrics and Gynecology, 1995
Our purpose was to evaluate the effectiveness of oxytocin, prostaglandin Ea intracervical gel, and estrediol cream for ripening the very unfavorable cervix in patients requiring induction of labor at term. STUDY DESIGN: This prospective, randomized study was conducted in a population of women with a very unfavorable cervix (Bishop score < 4) requiring induction of labor. The patients received prostaglandin Ea gel (0.5 mg) intracervically (three doses 6 hours apart), 4 mg estradiol cream in the anterior fornix of the vagina (three doses 6 hours apart), or oxytocin at induction per protocol with an infusion pump. RESULTS: Ninety-nine women were recruited into this trial and evenly distributed among the three groups. The demographics of maternal age, race, parity, gestational age, initial Bishop score, and indication for induction were similar among the groups. The incidence of cesarean deliveries was similar in the three groups with approximately 59% of pregnancies delivered abdominally. For patients undergoing abdominal delivery the maximum cervical dilatation among the oxytocin, estradiol, and prostaglandin E a groups was similar (3.90 -3.02 cm, 3.63 +-2.79 cm, and 4.65 _+ 2.78 cm, respectively; p > 0.05). For all patients birth weight and Apgar scores at 1 and 5 mintues were comparable across all regimens (p > 0.05). In the subset of patients delivered vaginally patients receiving oxytocin for cervical ripening had the greatest improvement in Bishop score over baseline (p = 0.023) with an improvement of 7.08 ---2.42. CONCLUSION: No differences were detected among prostaglandin E a gel, estrogen, and oxytocin in relation to cervical ripening in patients with an unfavorable cervix at term who require an induction of labor. Patients with a very unfavorable cervix at term who require delivery may benefit from serial ripening and inductions. (AM J OBSTET GYNECOL 1995;172:1702-8.)
International Journal of Gynecology & Obstetrics, 1999
Objecti¨e: To compare the effectiveness of extra-amniotic saline infusion versus extra-amniotic prostaglandin F ␣ 2 for cervical ripening, induction of labor and achievement of vaginal delivery in patients with unfavorable cervices. Method: A randomized trial of extra-amniotic saline infusion versus extra-amniotic prostaglandin F ␣ performed at 2 2 2 of first choice in resource-poor settings. ᮊ 1999 International Federation of Gynecology and Obstetrics
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2004
Objective: To study the pregnancy outcome of induction of labor with prostaglandin E2 (PGE 2 ) in women with one previous lower segment cesarean section. Methods: A retrospective cohort design was used. The study sample included 1028 consecutive women with one previous cesarean section, of whom 97 underwent induction of labor (study group) and 931 were admitted with spontaneous onset of labor (control group). Vaginal tablets of PGE 2 were used for cervical ripening in the study group. Mode of delivery, neonatal outcome, indications for cesarean section, and rate of uterine rupture were compared between the groups. Results: There were no significant differences between the study and control groups in mean (AES.D.) maternal age (30:9 AE 4:7 years versus 31:2 AE 4:8 years, P ¼ 0:6), gestational age at delivery (39:2 AE 1:8 weeks versus 39:3 AE 1:6 weeks, P ¼ 0:36), overall rate of cesarean section (36% versus 37.3%, P ¼ 0:8), rates of low 5-min Apgar score 7 (3.1% versus 3.7%, P ¼ 0:67) or cesarean section performed for nonreassuring fetal heart rate (6.1% versus 3.1%, P ¼ 0:1). There were four cases of uterine rupture, all in the control group compared to none in the study group (nonsignificant). Conclusion: The findings suggest that induction of labor in women with one previous cesarean section does not increase the risk of cesarean section rate and does not adversely affect immediate neonatal outcome. We cautiously suggest that when there is no absolute indication for repeated cesarean section, induction of labor may be considered.
A Comparison of Oestradiol and Prostaglandin E2 for Ripening the Cervix
BJOG: An International Journal of Obstetrics and Gynaecology, 1981
A study was conducted to compare the cervical ripening effect of extra-amniotic prostaglandin E, with that of extra-amniotic oestradiol valerate in preparation for induction of labour. Sixty primigravidae with an unripe cervix received one or other agent suspended in a viscous gel. The degree of cervical ripening was similar in both groups but more patients treated with prostaglandins became established in labour before planned amniotomy, and poor progress in labour was less common in this group.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Background: To compare the efficacy, efficiency and safety of extra amniotic Foley catheter with intracervical PGE2 gel and intravaginal misoprostol tablet for pre induction cervical ripening. Design of the study was to prospective randomized comparative study. Settings includes, this study was conducted in Mahatma Gandhi Medical College and Research Institute, Puducherry during November 2009 to May 2011. Methods: Participants for pre induction cervical ripening were randomized to receive either extra amniotic Foley catheter, intravaginal misoprostol tablet 25µg every four hours or intracervical PGE2 gel 0.5mg every six hours. The post ripening Bishop Score at 12 hours and 24 hours were assessed. The outcome measured was the time taken by the participants to achieve Bishop Score >5. The other outcomes included induction ripening interval, induction delivery interval, mode of delivery, requirement of additional agents, maternal and fetal complications. Results: The post ripening Bishop Score was significantly higher in PGE2 gel group with statistical significance. The induction ripening and the induction delivery interval was significantly shorter in misoprostol tablet group with a 'p' value <0.001. The incidence of NICU admission and other complications like meconium stained liquor, respiratory distress and maternal fever were more associated with misoprostol tablet group. Conclusions: PGE2 gel is an efficient agent for pre induction cervical ripening when compared to Foley catheter and misoprostol tablet though it is expensive, unstable and requires refrigeration. Tablet misoprostol significantly reduces the ripening duration, ripening delivery interval and the total duration to delivery. Misoprostol tablet is inexpensive, stable at room temperature and easy to administer. It also reduces the need for oxytocin augmentation. However the safety of misoprostol is still a concern due to increased maternal and neonatal complications. Foley catheter alone is not a good cervical ripening agent.